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The MVA ICD 071 form plays a crucial role in Maryland's Vehicle Insurance Compliance Program. This certified statement is essential for vehicle owners who face insurance lapses, providing a structured way to document circumstances surrounding these gaps. Key aspects of the form include personal information required from the owner, such as their driver's license number, case number, and details about the vehicle, including its make, model, and identification number. It necessitates owners to confirm that their vehicle was not operated, involved in accidents, or cited during the insurance lapse by specifying the time frame and location where the vehicle was parked. Owners must explain the reasons for the lapse and provide supporting documentation. Additionally, the form requires witness statements, either from individuals or repair facilities, verifying the owner’s claims. All parties involved must certify the accuracy of their statements under the penalty of perjury. Completing this form accurately is vital, as it helps mitigate legal consequences associated with insurance violations. For assistance or more information, the MVA contact details are conveniently provided at the bottom of the document.

Mva Icd 071 Example

Motor Vehicle Administration

6601 Ritchie Highway, N.E.

Glen Burnie, Maryland 21062

ICD-071 (12-13)

Maryland Vehicle Insurance Compliance Program – Certified Statement

Section 1: Owner’s Information and Statement of Facts

CASE NUMBER

INSURANCE CANCELLATION DATE

INSURANCE COMPANY

TAG NUMBER

TITLE NUMBER

VEHICLE IDENTIFICATION NUMBER:

YEAR:

MAKE:

VEHICLE OWNER (First, Last Name):

OWNER’S DRIVERS LICENSE NUMBER:

The vehicle listed above has not been driven, involved in an accident, or issued a citation during period of insurance lapse

 

to

 

. During this time the vehicle was parked at

MM/DD/YY

 

MM/DD/YY

 

(Location)

(Street Address)

(CIty)

(State)

(Zip Code)

For the following reason(s):

(Supporting documentation attached)

I certify, under penalty of perjury, that the statements made above are true and correct to the best of my knowledge, information and belief, under Section 12-109 b (2) of the Maryland Vehicle Law.

Signature Owner/Co-Owner

Date

Daytime Telephone Number

Section 2: Witness Statement of Facts

Witness A or Repair Facility - Business License #

I certify, under penalty of perjury, that the statements made above by the vehicle owner are true and correct to the best of my knowledge, information and belief, under Section 12-109(b) of the Maryland Vehicle Law.

Signature Witness

Drivers License Number

Date

Daytime Phone Number

Witness B

I certify, under penalty of perjury, that the statements made above by the vehicle owner are true and correct to the best of my knowledge, information and belief, under Section 12-109(b) of the Maryland Vehicle Law.

 

Witness Signature

Drivers License Number

 

Date

 

Daytime Phone Number

 

 

 

 

 

 

 

 

 

MVA Use Only

 

 

 

 

 

 

 

 

Moving Violation/Accident

No q

Yes q

Date:_______________

Case/Ticket #:________________

 

 

Prior Case:

No q

Yes q

Date:_______________

Case #:______________________

 

 

Adjustment Approved:

No q

Yes q

Amount:_____________

 

 

 

Authorized By:_ ________________________________________

ID:_ _________________

Date:__________________

 

For more information, please call: 410-768-7000 (to speak with a customer agent).

TTY for the hearing impaired: 1-800-492-4575. Visit our website at: www.MVA.Maryland.gov

Form Characteristics

Fact Name Fact Details
Form Title Maryland Vehicle Insurance Compliance Program – Certified Statement
Form Number ICD-071
Governing Law Section 12-109(b) of the Maryland Vehicle Law
Purpose This form certifies that a vehicle was not driven or involved in any incidents during a lapse of insurance.
Owner's Responsibilities The vehicle owner must provide accurate information regarding their vehicle and insurance status.
Witness Requirements Two witnesses must certify the statements made by the vehicle owner and provide their own information.
Contact Information For questions, call 410-768-7000 or visit www.MVA.Maryland.gov.

Guidelines on Utilizing Mva Icd 071

Filling out the MVA ICD-071 form is important for anyone needing to provide a certified statement regarding their vehicle insurance compliance in Maryland. Following these steps will help ensure that the form is completed correctly, which is essential for your case.

  1. Begin by filling out the CASE NUMBER, which is usually provided to you.
  2. Enter the INSURANCE CANCELLATION DATE.
  3. Fill in the name of your INSURANCE COMPANY.
  4. Input your vehicle's TAG NUMBER.
  5. Provide the TITLE NUMBER of your vehicle.
  6. Complete the VEHICLE IDENTIFICATION NUMBER (VIN).
  7. Indicate the YEAR and MAKE of your vehicle.
  8. Enter your name as the VEHICLE OWNER (First, Last Name).
  9. Include your OWNER’S DRIVERS LICENSE NUMBER.
  10. State the period of insurance lapse by filling in the two dates: MM/DD/YY first for the start and then for the end.
  11. Provide the LOCATION where the vehicle was parked during this period, including the STREET ADDRESS, CITY, STATE, and ZIP CODE.
  12. List the reason(s) for not driving the vehicle during the lapse period, and make sure to attach any supporting documentation.
  13. Sign and date the certification under penalty of perjury to confirm your statements are true.
  14. Provide your DAYTIME TELEPHONE NUMBER.

After completing Section 1, if witnesses are required, move on to Section 2. Make sure they also provide their details and signatures, certifying the accuracy of your statements. Once everything is filled out, you can submit the form as instructed.

What You Should Know About This Form

What is the MVA ICD 071 form?

The MVA ICD 071 form is a document used in Maryland as part of the Vehicle Insurance Compliance Program. It's essentially a certified statement that vehicle owners fill out to confirm that their vehicle has not been driven or cited during a lapse in insurance coverage.

Who needs to complete the MVA ICD 071 form?

Vehicle owners in Maryland who have experienced a lapse in vehicle insurance coverage are typically the ones required to complete this form. If your vehicle has been parked and not in use during this period, you will need to fill it out.

What information is required on the form?

You’ll need to provide several details: your vehicle’s identification number, the reason for the insurance lapse, and location details where the vehicle was parked. Additionally, you'll supply your personal information, including your name and driver's license number.

What is a 'certified statement'?

A certified statement is a declaration in which you affirm that the information you provided is true to the best of your knowledge. When you sign the form, you are affirming this under penalty of perjury, which means that providing false information could lead to legal consequences.

What supporting documentation is required?

You must include documents that support your claims in the form, such as proof of parking location or any other pertinent evidence that shows the vehicle wasn’t in use. This documentation helps confirm your statement regarding the reasons for the insurance cancellation.

Do I need witnesses to sign the form?

Yes, the form requires signatures from witnesses, which could be friends, family members, or a repair facility owner. Their signatures verify the truth of your statements about the vehicle's status during the lapse in insurance.

How do I submit the MVA ICD 071 form?

The completed form can typically be submitted to the Maryland Vehicle Administration either by mail or in person at one of their offices. Be sure to double-check the most current submission guidelines to ensure it reaches the right destination.

What if I have questions while filling out the form?

If you run into questions or need assistance, you can reach out to the Maryland Vehicle Administration's customer service at 410-768-7000. They can provide you with helpful information and clarification.

What happens after I submit the form?

Once your form is submitted, the MVA will review it along with any supporting documentation. If everything checks out and the information is deemed accurate, you should receive confirmation regarding your vehicle’s insurance compliance status.

Common mistakes

Filling out the MVA ICD-071 form correctly is essential for compliance with Maryland's insurance requirements. However, many people make common mistakes that can delay their processing or lead to rejections. Understanding these pitfalls can streamline the process and ensure a smoother experience.

One frequent error occurs in the Owner’s Information section. Failing to provide the correct vehicle identification number (VIN) can cause significant problems. The VIN is crucial for identifying the vehicle in question. Double-checking this number is essential, as a simple typo can result in the form being invalidated.

Another common mistake is not properly documenting the reason for the insurance lapse. Many individuals underestimate the importance of a detailed explanation. It’s essential to include the specific reasons and to ensure that supporting documentation is attached. Without this, the form may not hold up against scrutiny, leading to potential penalties.

Signature issues often arise as well. The certification section must contain the correct signatures of both the vehicle owner and the witnesses. Failure to sign or providing an incorrect signature can halt the process. Ensure that all signatures are clear and correspond with the names listed on the form.

In Section 2, errors also crop up regarding the witness statements. Some people forget to include complete contact information for their witnesses. This can hinder follow-up or verification needed by the MVA. Providing thorough and accurate details enhances the credibility of the claims made in the form.

Lastly, individuals sometimes overlook the importance of the date. It may seem trivial, but submitting a form without a date, or with an incorrect date, can lead to confusion about the timeline of events. Keeping every detail in check will minimize complications and ensure that the form is processed efficiently.

Documents used along the form

The MVA ICD 071 form serves as a certified statement for the Maryland Vehicle Insurance Compliance Program, primarily addressing issues related to lapses in vehicle insurance. When dealing with this form, several other documents may be necessary to complete the process effectively. Below is a list of forms often associated with the MVA ICD 071 form, each with a brief description of its purpose.

  • Proof of Insurance: This document verifies that a vehicle is insured. It is often required to demonstrate compliance with state insurance laws.
  • Vehicle Title: The vehicle title is a legal document that states ownership of a vehicle. It is important for establishing rights over the vehicle and may be needed to transfer ownership or to register it.
  • Registration Application: This form is used to register a vehicle with the state's Motor Vehicle Administration. It usually requires details about the vehicle and its owner.
  • Bill of Sale: This document provides proof of the transaction between the buyer and seller of a vehicle. It outlines the terms of sale, including the purchase price and vehicle information.
  • Affidavit of Non-Operation: In cases where the vehicle has not been driven, this form certifies that the vehicle was not operated during a specified time period, often needed to avoid penalties for insurance lapses.
  • Certificate of Title Application: This form is used to apply for a new title when ownership changes occur, or when a vehicle is newly purchased. It documents the transaction and ensures the title is updated with current ownership.
  • Vehicle Inspection Certificate: Certain states require vehicles to pass an inspection before they can be registered or insured. This certificate proves the vehicle meets safety and emissions standards.
  • Release of Liability: This form releases the previous owner from any future liability once a vehicle has been sold. It is essential for document safety and can protect the seller from potential legal issues.
  • Financial Responsibility Form: This document indicates that a vehicle owner has the financial means to cover potential damages resulting from accidents. It is often required to show proof of financial responsibility.

Completing the MVA ICD 071 form and its associated documents accurately is vital for compliance with Maryland state laws regarding vehicle insurance. Having the relevant documents prepared can facilitate a smoother process and help avoid unnecessary legal complications.

Similar forms

  • Form MV-2: Similar to the MVA ICD 071, the MV-2 form is utilized to report vehicle ownership transfers and to confirm that the vehicle hasn’t been driven or involved in incidents that would affect insurance coverage.
  • Form SR-22: This document is a certificate of insurance specifically for high-risk drivers. Like the MVA ICD 071, it certifies proof of insurance compliance but serves for individuals needing to demonstrate coverage during a period of reinstatement.
  • Form FR-44: The FR-44 is akin to the SR-22 but is required in cases involving certain offenses. Both documents affirm that the vehicle is insured, though the FR-44 typically carries higher coverage limits.
  • Form MVR-30: This form is used to verify a motor vehicle accident and may document the insurance status at the time of the incident. Like the MVA ICD 071, it requires detailed information about the vehicle’s condition and ownership during the stated period.
  • Form MV-46: The MV-46 is a statement of facts for an insurance verification related to commercial vehicles. It shares similarities with the MVA ICD 071 in that both forms require thorough documentation of the vehicle's insurance status and use.
  • Form VSA-14: This is a Virginia form designed to declare a vehicle's non-use status. The process is similar as it asks for the owner’s information and supporting documents to verify that the vehicle was not driven during the insurance lapse.
  • Insurance Declaration Page: This document proves insurance coverage and contains information similar to the MVA ICD 071 about the vehicle's status. Both require verification of the vehicle’s condition during the insurance period.
  • Title Application: When applying for a vehicle title, the form often requires similar declarations about the vehicle's use and insurance. Like the MVA ICD 071, it functions to ensure proper insurance compliance for ownership validation.

Dos and Don'ts

Filling out the MVA ICD 071 form is a significant step in complying with the Maryland Vehicle Insurance Compliance Program. To help streamline this process, here are five essential do's and don'ts to keep in mind:

  • Do ensure accuracy in all the information you provide. Carefully check each section for mistakes or omissions.
  • Do attach supporting documentation. If you have supporting evidence for your reasons for the insurance lapse, include it with your form.
  • Do sign and date your form. A signature confirms your agreement with the information provided, and dating it establishes a timeline for your submission.
  • Do use clear and legible handwriting. This makes it easier for the review team to process your application without confusion.
  • Do keep a copy of your completed form for your records. It's always good practice to have documentation for your files.
  • Don't rush through the form. Take your time to read the instructions thoroughly to avoid errors.
  • Don't leave any fields blank. If a section does not apply, indicate "N/A" instead of leaving it empty.
  • Don't forget to provide contact information. Having your daytime phone number can help facilitate communication if further clarification is needed.
  • Don't underestimate the importance of the witness statements. Ensure that witnesses are informed and their signature is included where necessary.
  • Don't ignore submission deadlines. Be aware of any timelines you need to meet when sending in your form to remain compliant.

Following these guidelines will make the process smoother and help prevent delays in the review of your MVA ICD 071 form. Good luck!

Misconceptions

Understanding the MVA ICD 071 form can be daunting. Here are ten common misconceptions about this important document, along with clarifications to help you navigate the process.

  • Myth 1: The MVA ICD 071 form is only for vehicle accidents.
  • This form is not just for incidents involving accidents. It is primarily used to certify vehicle insurance compliance.

  • Myth 2: Anyone can fill out the MVA ICD 071 form.
  • Only the vehicle owner or authorized individuals can complete the form to ensure that the information is accurate and truthful.

  • Myth 3: All fields are mandatory on the form.
  • While many fields must be completed, some sections may be fillable depending on the situation. Check the requirements before you start.

  • Myth 4: You don’t need supporting documents.
  • Supporting documentation is often required to validate the claims made on the form. Without these documents, the application may be incomplete.

  • Myth 5: The form can be submitted online.
  • This form typically must be submitted in person or via mail to your local MVA office. Always check for updated submission methods.

  • Myth 6: You can ignore the witness signature requirement.
  • The form requires one or two witness signatures, depending on the circumstances. Omit this section, and your application may be rejected.

  • Myth 7: The MVA will automatically contact my insurance company.
  • It is the responsibility of the vehicle owner to provide accurate insurance information. The MVA does not reach out to your insurance company for verification.

  • Myth 8: There is no penalty for providing false information.
  • Submitting false information can lead to severe penalties, including legal repercussions. Honesty is crucial when completing the form.

  • Myth 9: The case number is optional.
  • The case number is an essential part of the MVA ICD 071 form. It helps track your submission and any potential follow-up.

  • Myth 10: Once submitted, the form cannot be updated.
  • If you realize an error after submitting the form, you can contact your local MVA office to discuss your options for correction.

Being informed about these misconceptions helps ensure a smoother process when dealing with the MVA ICD 071 form. Always double-check the latest guidelines and instructions provided by the MVA for the most accurate information.

Key takeaways

Completing the MVA ICD 071 form is essential for vehicle owners in Maryland who need to verify their insurance compliance status. Here are nine key takeaways:

  • Be Accurate: Ensure that all information, including names, dates, and identification numbers, is correct and matches official documents.
  • Document Your Situation: Clearly state the reasons for the insurance lapse. Supporting documentation should be attached to back up your claims.
  • Provide Detailed Vehicle Information: Include the vehicle identification number (VIN), make, model, and year.
  • Collect Witness Statements: Engage witnesses or repair facilities to validate your statements, as their signatures are required for authenticity.
  • Understand Your Responsibilities: By signing, you certify the truthfulness of your claims under the penalty of perjury.
  • Follow Submission Guidelines: Submit the form according to MVA directions to avoid delays in processing.
  • Keep a Copy: Retain a copy of the completed form for your records. This ensures you have proof of submission.
  • Know the Processing Time: Be aware that it may take time for the MVA to process your form; plan accordingly.
  • Contact MVA for Assistance: If you have questions or require further guidance, reach out to MVA customer service at 410-768-7000.

Successful completion and submission of the MVA ICD 071 form can help mitigate potential penalties associated with uninsured periods.